calling

Levo is a great first line pressor fora septic patient who has already been volume resuccitated. It worksby vaso constricting the extremeties to adequately profuse coreorgans. The problem with neo is a) it is a weak pressor (nice forpushing in the OR if the patient gets too much prop!) and b) it worksin the same way as levophed, so many intensivists don't use it as asecond pressor because it really doesn't make sense. If 20 or 30 oflevo doesn't work, than adding neo probably won't help. Vaso is agood second-line pressor for sepsis. After that, you're desperateanyway, so neo won't hurt. I don't think I've seen anyone survive whohas needed more than three pressors. No wait, there was one!